City of Cupertino

Online Commission Application

*Full Name

*Address

*Home Phone

*Business Phone

*Gender

*Email

How long have you been a resident of the City of Cupertino?

*Occupation

#	Name of School	Major	Years/Credit
High School
Junior College
University
Business/Trade School
Other Training

Professional Licenses or Registrations

* On which Advisory Commissions, Committees, or Boards would you like to serve?

(List in order of preference. List no more than two)

* What public office or offices do you currently hold?

required

Please list your qualifications for this position

Are there any special interests or activities that you wish to bring to the attention of the City Council?

(These need not be directly related to the appointment that you are seeking.)

* Do you have any obligations that might affect your regular attendance at scheduled evening meetings?

Where did you hear about the commission vacancy?

* Are you related to anyone currently serving on a commision?

required

The space below is provided for any additional comments that you may wish to make about yourself or the position being sought.

If you are not selected at this time, we will keep your application on file for a one (1) year period for consideration should a commission vacancy occur.

I certify that I am not an official or employee of the City of Cupertino, nor related by blood or marriage to any official or employee of the City of Cupertino.

I understand that all information provided on this form becomes a public record.
I understand that all applicants appointed to any commission or committee will be required to file statements of Economic Interest, which are also a public record.